Federal University of São Paulo

About: Federal University of São Paulo is a education organization based out in São Paulo, Brazil. It is known for research contribution in the topics: Population & Medicine. The organization has 27971 authors who have published 49365 publications receiving 935536 citations. The organization is also known as: Universidade Federal de São Paulo & Universidade Federal de Sao Paulo.

Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa

Abstract: Background: Anorexia nervosa is a disorder with high morbidity and significant mortality. It is most common in young adult women, in whom the incidence may be increasing. The focus of treatment has moved to an outpatient setting, and a number of differing psychological therapies are presently used in treatment. This is an update of a Cochrane review which was last published in 2008. Objectives: To assess the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents treated in an outpatient setting. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialised Register (CCDANCTR) (16 July 2014). This register includes relevant randomised controlled trials from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We screened reference lists of all included studies and sent letters to identified, notable researchers requesting information on unpublished or ongoing studies. Selection criteria: All randomised controlled trials of one or more individual outpatient psychological therapies for adults with anorexia nervosa, as defined by DSM-5 or similar international criteria. Data collection and analysis: We selected a range of outcome variables, including physical state, severity of eating disorder attitudes and beliefs, interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons used the mean or standardised mean difference (MD or SMD), and binary outcome comparisons used the risk ratio (RR). Two review authors (PH and AC or ST) extracted data independently. Main results: We identified 10 trials from the search, with a total of 599 anorexia nervosa participants, and included them in the review. Seven had been identified in the previous versions of this review and we now include three new trials. We now deem one previously identified ongoing trial to be ineligible, and six ongoing trials are new for this update. Two of the 10 trials included children. Trials tested diverse psychological therapies and comparability was poor. Risks of bias were mostly evident through lack of blinded outcome assessments (in 60% of studies) and incomplete data reporting (attrition bias). The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate outcome on the Morgan and Russell Scale (RR 0.70, 95% confidence interval (CI) 0.51 to 0.97; 1 RCT, 40 participants; very low-quality evidence). However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, 71 participants; very low-quality evidence), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological therapies and TAU. Two trials found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMIMD-0.00, 95% CI -0.91 to 0.91; 197 participants, low-quality evidence). When comparing individual psychological therapies with each other, no specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (35 participants). None of the trials identified any adverse effects. Insufficient power was problematic for the majority of trials. Authors' conclusions: There was a suggestion in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents. Larger RCTs of longer treatment duration and follow-up are needed.

Versão brasileira do Dizziness Handicap Inventory

Abstract: Background: impact of dizziness on life quality (LQ). Aim: to adapt the Dizziness Handicap Inventory (DHI) for application in the Brazilian population; to assess its reproducibility; and to describe the results obtained in patients with chronic dizziness. Method: The DHI was initially applied in 45 patients with chronic dizziness and with a clinical diagnosis of vestibular syndrome. The application followed the stages of translation - from English to Portuguese - and linguistic adaptation, grammatical and idiomatic equivalence review and evaluation of its intra and inter-researchers reproducibility. Reproducibility was assessed by using the Wilcoxon Test for two dependent samples, P < 0.05. The questionnaire was applied on 250 patients with chronic vestibular syndrome in order to evaluate the impact of dizziness on LQ. Results: The Brazilian version of the DHI (Brazilian DHI) was well comprehended by the studied population and no statistically significant difference was found in the inter-researcher (P = 0.418) and intra-researcher (P = 0.244) reproducibility. All of the studied patients presented a loss in LQ due to dizziness. Aspects which were most affected were the physical ones, followed by, in a decreasing order, the functional and the emotional ones. Functional aspects were more compromised in older individuals. No association was verified between gender and the overall mean scores of the DHI and between gender and the mean scores of each aspect assessed by the DHI. Conclusion: the DHI was culturally adapted for application in the Brazilian population (Brazilian DHI). This instrument was considered to be a reliable tool to evaluate the impact of dizziness on LQ. Patients with chronic dizziness and with clinical diagnosis of vestibular syndrome presented a loss in LQ, due to this symptom. This loss was verified by the application of the Brazilian DHI. Physical aspects were the most compromised.